1
2	EMS/CSO PROGRAM A program intended to provide municipally operated Emergency Medical Services and other services to the residents and guests of Jackson Township by trained, professional Community Service Officer Emergency Medical Technicians
3	Levels of Pre-Hospital Care New Jersey’s Two-tiered system: EMERGENCY MEDICAL TECHNICIAN E.M.T. Basic Life Support Service (B.L.S.) Towns may provide this service MOBILE INTENSIVE CARE PARAMEDIC Advanced Life Support (A.L.S.) Restricted by State regulation Towns may not provide this service
4	=
5	Jackson Township Department of Public Safety Division of Emergency Medical Services Why Municipally-based BLS? Response to Township Concerns Adoption of EMS System Review* suggestions *State of New Jersey Department of Health and Senior Services Office of Emergency Medical Services EMS System Review August 2007
6	Response to Township Concerns The need to provide consistent and reliable EMS to Jackson Township With volunteer and third-party EMS/BLS service, complaints, questions and problems are deferred to other organizations, leaving little ability for the Township to manage such concerns, while the Township maintains the liability for the service provided.
7	Adoption of EMS system review In 2006, the State of New Jersey commissioned a study to assess its Emergency Medical Services (EMS) system, in a study mandated by the New Jersey State Legislature This review, published in August 2007, identified the state of the EMS system in the state “in a state of near crisis”, citing, in part, a “decline in volunteer membership”. “Weaknesses” were identified in the delivery of EMS, including “First Aid Squads not able to guarantee transport services, fewer people able to volunteer, and some volunteer services are not well managed. Fifty-five (55) recommendations were presented in this review
8	EMS System Review Recommendations, in part: Legislation should be passed that requires local municipalities to provide EMS… this obligation should be similar to the obligation to provide law enforcement and fire services All EMS provider agencies should be licensed by NJOEMS (currently only paid services are licensed) In theory, this licensure will help to maintain objective standards in EMS. No licensure or staffing standards yet exist for volunteer EMS.
9	EMS System Review Recommendations, in part: NJOEMS in conjunction with the NJ EMS Council should determine response time standards for EMS that apply to all agencies. There are currently no response time standards in New Jersey Within five years, all EMS response units should be equipped with AVL (automatic vehicle locators). Jackson Twp. has this capability
10	EMS System Review Recommendations, in part: All BLS ambulances must be staffed with at least two (2) NJ certified/licensed EMT-B’s. The current volunteer system does not have to comply with this recommendation, allowing for the possibility of a lesser-trained crew staffing their BLS ambulances, such as “drivers” and teenage “cadets”.
11	Municipally-based EMS The future is here Oversight Consistency Flexibility Additional Services Self-sufficiency
12	The future is here Numerous local municipalities are providing Municipal EMS services: Lakewood Township Toms River Township, since 2002 Brick Township, since 2006 Howell Township, since 2005 Wall Township Other local municipalities are also contemplating initiating their own municipal EMS service
13	Oversight Guaranteed, thorough police background checks Daily interaction would ensure real-time supervision of staff Questions, problems or concerns can be addressed immediately, without having to go to outside agencies, through their respective managers Practices and policy changes can be immediately implemented Ability to change assignment of crews as peak call volumes and locations change Real-time deployment of BLS units where they are statistically most likely to be needed. -2/3 of EMS calls are on the east side of the Township In a sampling of 2,763 EMS calls: 62% were in the North and East sections of the Township 20% were in the Northwest section of the Township
14	Consistency The history of paid EMS in Jackson Twp.: 1995 SAS Ambulance Service 1995-1997 MONOC 1997-1999 AMR 1999-2003 EMTAC 2003-Present MONOC 2008 ????? A municipal service would establish consistency in the provision of emergency medical services
15	Flexibility The current bid process inhibits the ability to make spontaneous, real-time changes, such as adding BLS units or changing schedules. By establishing this program, Jackson Township would lay the groundwork for a program which can be adapted for the dynamic, changing needs of this community.
16	Additional Services In addition to dedicated EMS, staff could perform tasks such as: In home vital sign courtesy screening Well being checks for ill or unaided persons Vacant property checks Car seat checks Lockouts And much more
17	Self-sufficiency By billing for BLS services, it has been well established that such a program should incur no expense liability. No other Township emergency service has the likelihood of being self-sustaining. Jackson Township recently solicited Requests for Proposals for BLS service in the Township, with eight (8) service options being defined. Each of those options is explored below, with the associated Salary ranges and probable revenue to be generated (revenues projected based upon information provided by two professional medical billing vendors).
18	Option #1: 3 trucks 6 am – 6 pm
19	Option #2: 3 Trucks 6 am – 11 pm
20	Option #3: 3 Trucks 24 hours
21	Option #4: 3 Trucks 6am-6pm 2 Trucks 6pm-11pm
22	Option #5: 3 Trucks 6am-6pm 2 Trucks 6pm-6am
23	Option #6: 2 Trucks 6 am-6pm
24	Option #7: 2 Trucks 6am-11pm
25	Option #8: 2 Trucks 24 Hours
26	Data Sources EMT Salary Range: Minimum Maximum Full Time $33,006 $45,745 Part Time $13.00/hr. $22.00/hr. Ordinance 26-07, amending Ordinance 05-07, adopted August 28, 2007 EMS Calls Calendar year 2007 Total Calls (approx.) 4,435 Daytime Calls (6am-6pm) 2,602 Nighttime Calls (6pm-6am) 1,833 Evening calls (6pm-11pm,approx.) 1,200 Billable calls (approx.) 84% Projected revenues Vendor #1 $310.95/call +/- 3% ($301.62 - $320.27) Vendor #2 $259.80 - $329.90
27	Response Times A study was conducted of available data from March 01, 2007 through September 30, 2007, with the following results:
28	Medical Billing A municipality can bill medical insurance carriers for BLS services. Only a municipality, not a commercial BLS provider, may elect not to bill a patient for the balance of a bill, thereby further servicing residents of Jackson Twp. by providing this service at no individual cost to them. Recovery of funds can be expected beginning in as little as ninety days. US Dept. of Health & Human Services, Office of the Inspector General Advisory Opinions 01-11 and 01-12, issued July 20, 2001.
29	Start-up Costs With eight (8) service options having been projected, the start-up costs will adjust for the number of staff required in each scenario. Options 6, 7 and 8 clearly show the probability of this program being self-sufficient. As BLS call volumes continue to increase, so will the opportunities to recover program expenses through medical billing.
30	Start-up Costs Year one projected expenses would include purchases such as: One (1) ambulance $130,000* Radio, Telephone and Computer Equipment $28,000* Employee backgrounds, medical & psychological Screening, vaccinations, $25,000 Emergency Medical Supplies $7,700 Office supplies and equipment $2,600* *Most of these start-up expenses would provide non-consumables which will last for many years, which represent non-recurring costs. A full working budget to execute the start-up of this new Township Department EMS program, based upon Option #6, has been suggested at $250,291.25. After deducting such non-recurrent costs, the operating expenses can be tallied at less than $100,000.00
31	Conclusion Jackson Township could elect to take the management of Emergency Medical Services into its own hands, and could do so with a program which is flexible, dynamic, contemporary and fiscally self-sufficient.